Method and apparatus for treating edema and other swelling disorders

ABSTRACT

This invention is an apparatus for treating lymphedema having a sleeve with inwardly projecting-elastomeric fingers and externally fitted pressure adjusting circular bands. When the sleeve is fitted to a patient&#39;s limb, the fingers impose a grid pattern of pressure points against skin of swollen limb. Space around and between the pressure points provide channels under the skin through which lymphatic fluids are able to migrate up the arm to the shoulder where healthy nodes process it and channel it to the large veins. Similar applications are applied to other limbs, hands, and feet with sleeves, and to the shoulder, chest wall, and back with vests.

This application is a continuation-in-part of application Ser. No.08/390,866 filed on Feb. 17, 1995, abandoned the full disclosure ofwhich is incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to medical devices and methods,and in particular to a device and method for removing edema fluids froma body trunk and/or extremity such as an arm or a leg.

Breast cancer is a serious disease in women, and a variety of modalitiesare employed in its treatment. Many of these treatments result in damageto the lymphatic and/or venous system which, in turn, can cause acondition referred to as "lymphedema." Lymphedema is the accumulation ofexcessive lymph fluid and swelling of subcutaneous tissues due to theobstruction or destruction of lymph vessels. In breast cancer patients,lymphedema occurs in the arm and results in painful swelling. Excessivefluid accumulation, referred to as edema, can also arise in the arms,legs and, trunk from a variety of other causes, including infection,radiation therapy, and other conditions which result in damage to ordestruction of portions of the lymphatic and/or venous system.

2. Description of the Background Art

A variety of devices and methods have been proposed for the treatment oflymphedema in the arms and elsewhere. Many such devices utilize asequential pump which works like a multiplicity of blood pressure cuffsextending from the shoulder to the hand, which contract and expandindividually. When pressure is exerted by any one chamber or cuff, itapplies a `blanket pressure` (i.e. an annular pressure which completelycircumscribes the limb or other body portion) to the skin directlyunderneath the area of that chamber. When the pressure upon that area isreleased, a similar blanket pressure is then applied to the portion ofthe arm covered by the next adjacent chamber, and so on up the arm. Suchblanket pressures are applied sequentially from the distal to theproximal ends of the arm, with the intention of forcing the fluids upthe arm and into the trunk of the body, where existing lymph nodes canprocess them.

Another prior mode of treatment has been a double walled sheath orstocking in which air pressure is introduced between the walls tosqueeze the limb. It has been found that this and other similar systems,which rely on uniform blanket pressure application through the length ofthe afflicted limb or portions thereof, do not perform very well and infact may interfere with the desired distal-to-proximal flow of lymphaticfluid.

We have found that when a uniform and/or excessive pressure is appliedto an area for the purpose of moving fluid, the opposite effect mayresult. In particular, the application of pressure may: 1) compress theveins and lymph ducts, resulting in blockage; 2) augment capillary leak;and 3) prevent the lymphatic fluids from mobilizing.

Other approaches to treatment have included employment of a sheath thatis separated into a number of longitudinally spaced inflatable air cellsencircling the limb to be treated. These cells are successively inflatedwith uniform air pressure from the distal end to the proximal end of thesheath with the intent of promoting fluid flow in the desired direction.Such systems have been largely ineffectual, as they rely on air pressurebeing maintained at the same level or magnitude in any one of, or all,of the pressurized cells, producing a blanket effect. U.S. Pat. Nos.2,533,504 and 2,781,041 disclose examples of such systems.

Prior U.S. Pat. No. 4,370,975 discloses an apparatus for treatinglymphedema and similar fluid retention afflictions through the use of amulti-cell inflatable sheath which encompasses the swollen limb.Pressure is applied in the cells of the sheath in timed sequence fromthe distal cell to the proximal cell, the sequence of pressure appliedalso defining a decreasing gradient pressure from a maximum pressureapplied in the distal cell to a minimum pressure applied in the proximalcell when all of the cells are pressurized. Generally, for each of theadjacent cells the more distal has applied a higher pressure than themore proximal. This application of gradient pressure from distal toproximal cells in time sequence comprises a cycle, and such cycle may berepeated indefinitely to promote the flow of lymphatic fluid from theafflicted limb in a proximal direction.

The problem with the above methods is that any form of blanket pressuresuch as that applied by pneumatic or hydraulic pressure to largeafflicted areas will have at best a minimal result.

Carter, 5,063,910 shows an apparatus for treating vascular, metabolicand functional imbalance of a limb by variations in pressure of ahigh-density fluid, such as a mercury bath, around the limb.

The problem with this device is that the pressure applied by this meansis, in fact, a blanket-pressure, which increases with the depth of thelimb portion within the fluid bath, resulting in the disadvantagesdescribed above for al other pressure systems. Another disadvantage isthat the patient must remain immobilized during treatment.

R. W. Lilligren et al, U.S. Pat. No. 3,454,010, shows a hollow tube-likebandage for wrapping in a spiral-like manner around the limb of apatient, into which is then applied a pneumatic pressure, which isintended to drive out excess fluids prior to surgery.

Once again the pressure applied is a uniform or blanket pressure to theskin, and so is relatively ineffective to reduce swelling.

Ewen, U.S. Pat. No. 5,257,956, shows a garment for use bypost-mastectomy patients which alleviates post-operative pain anddiscomfort and facilitates normal activity during the recovery period. Apadded vest-like garment is adapted for applying comforting pressure tothe sites of removal of breast and other tissues and for holding painrelieving packages.

Again, the problem with this garment is that it applies a blanketpressure, resulting in little reduction in swelling.

Fregealle, U.S. Pat. No. 3,975,929, shows a stocking knit on a circularknitting machine which provides a gradually decreasing compressive forceon the leg of the of the wearer from the ankle upwardly to the top ofthe stocking. Again, we believe that a uniform or blanket-pressure suchas is applied by this device, is not the best method for forcing outexcess lymphedema fluids.

In all of these pressure-applied methods, the patient is immobilized upto 4 hours per day, and sometimes several days in succession, sufferingfollowing treatment and soreness of the arm for many days afterwards.

It is a well established fact that special exercises followingmastectomy help to mobilize lymphedema fluids; yet prior art devicescontribute toward immobilizing the patient, making exercising difficultor impossible. Thus resulting in a counter-producing effect.

The cost of sequential pumps including necessary limb compressionapparatus range from $500 to over $8,000. In addition, skilledtechnicians are necessary to operate it, thereby making treatment forlymphedema patients extremely expensive.

The following cited prior art references are relevant but distinguishedfrom the present invention: U.S. Pat. Nos. 2,533,504, 2,699,165,2,781,041, 2,943,859, 3,173,420, 3,454,010, 6,548,819, 3,561,435,3,728,875, 3,845,769, 3,862,629, 3,885,554, 3,942,518, 3,975,929,4,013,069, 4,030,488, 4,180,065, 4,320,746, 4,370,975, 4,374,518,4,402,312, 4,552,133, 4,583,522, 4,773,397, 4,922,893, 4,938,208,4,961,418, 5,108,426, 5,109,832, 5,117,812, 5,171,211, 5,172,689,5,228,142, 5,233,974, 5,257,956 and 5,310,400.

SUMMARY OF THE INVENTION

The present invention provides improved apparatus and methods fortreating body parts of the patient, particularly the limbs, to relieveswelling due to lymphedema and other causes. The apparatus comprise amultiplicity of pressure-applying resilient protrusions such as fingersor ridges which are arranged to apply inward pressure onto a surface ofthe body part to relieve swelling. The protrusions will be formed from acompressible material, such as foam rubber, and pressure will be appliedby wrapping or otherwise compressing or collapsing the protrusions ontothe body portion so that the fingers apply a controlled level ofpressure onto a localized area over the body part surface. In allembodiments, the protrusions will be spaced-apart in an array so thatthe tips of the fingers or ridges which engage the body part surfaceapply pressure in a spaced-apart manner. Surprisingly, it has been foundthat applying such a distributed pattern of spaced-apart pressure pointsor lines against the skin effectively reduces swelling resulting fromlymphedema and other edemas in a simple and cost-effective manner. Inparticular, the method and apparatus of the present invention do notblock or inhibit fluid flow within the body part, further enhancing thebody's ability to resorb the fluid responsible for swelling. Anadditional advantage of the device is that it is both simple andcomfortable to use, enhancing patient compliance. In the treatment oflymphedema, the apparatus and method of the present invention haveparticularly been found to permit the release and flow back of fluid tothe remaining healthy lymph nodes in a controlled manner that does notoverburden such collateral lymphatic drainage.

In a specific embodiment of the present invention intended for use withthe limbs of the body, i.e., the arms and legs, the resilientprotrusions will have a height from a radially outward base to aradially inward tip in the range from 0.5 cm to 15 cm. The protrusionsare arranged in a generally cylindrical envelope with individual fingersor ridges being aligned radially inwardly with respect to the axis ofthe cylindrical envelope. The length of the cylindrical envelope willdepend on the body part being treated, e.g. from about 3 cm for a fingerto 200 cm for trunk and legs. In an apparatus intended specifically foruse with an arm, the length of the cylindrical envelope is in the rangefrom 10 cm to 90 cm, the bases of the fingers are distributed over agenerally cylindrical surface having a diameter in the range from 7.5 cmto 75 cm, and the tips of the fingers are distributed over a generallycylindrical surface having a diameter in the range from 2 cm to 15 cm.The diameters, of course, will vary widely for treatment of other bodyparts.

The device will further comprise at least an outer sleeve which securesthe base of the fingers over the generally cylindrical outer surface.The outer sleeve will generally be formed from a non-distensiblematerial, such as nylon fabric, permitting the fingers or ridges to berolled to form the generally cylindrical envelope. The device willusually further comprise an axial fastener, such as a zipper, whichallows the rolled fabric to be opened and closed. Alternatively oradditionally, the device may comprise plurality of straps which allowthe rolled fabric to be radially inwardly compressed against the bodypart, e.g., by cinching the straps to a desired level of internalcompression. The ability to adjust the pressure applied to the bodysurface is important to the success of the present invention. The devicemay further comprise an inner sleeve to cover the radially inward tipsof the fingers over a generally cylindrical surface. The inner sleevewill be intended primarily for comfort and cleanliness and will beformed from a soft, relatively thin material which allows the resilientfingers to apply pressure to the body part surface.

In a more specific embodiment the resilient protrusions will be providedby a sheet of convoluted plastic foam which, when unrolled, has aplurality of protuberances projecting upwardly from a base surfacethereof. The protuberances typically form cylindrical fingers or axiallyaligned ridges which are tapered to a smaller width in the directionaway from their base. The sheet of plastic foam can be rolled into thedesired cylindrical envelope configuration described above. The taperingof the protrusions is a particular advantage since it permits rolling ofthe foam rubber sheet with excessive compression of the inner surface ofthe sheet.

A principle feature of the present invention is the provision of animproved device for applying pressure to a patient's limb for thepurpose of facilitating the flow of lymphedema fluid up the limb to theshoulder. This feature includes a sleeve which can be slipped over thepatient's limb and which contains a multiplicity of inwardly-pointedpressure-applying resilient fingers or ridges. The fingers arepreferably arranged in rows, and the rows are arranged side-by-side suchthat the fingers form a grid pattern having space around each finger andbetween the rows. Each finger individually exerts pressure against asmall area of the skin, and each small area is separated by space. Theseparation of individual fingers is an advantage particular in that itallows for more precise control of pressure and pressure gradientapplied to the body surface.

Another feature of the present invention is that each protrusionprovides controlled pressure against the adjacent body surface, which inturn allows the fluid to be mobilized back to the lymphatic and venoussystem. It is important that the applied pressure be sufficiently greatto promote flow of excess fluid from tissue back into vascular (venousand lymphatic) circulation and thereby reduce swelling. It is equallyimportant that the applied pressure not be so large that fluid isimpeded from returning to vascular circulation. It has been found thatan applied pressure in the range from 5 mmHg to 60 mmHg is usuallysufficient, preferably from 10 mmHg to 45 mmHg. The precise appliedpressure will usually be slightly lower than venous and lymphaticoutlfow pressure, typically being about 1 mmHg to 10 mmHg below theindividual patient's venous pressure.

The devices of the present invention have been found to be particularlysuitable for maintaining the desired controlled pressures needed for thetreatment methods. In particular, use of the foam inner layer allows thecompressive force to be applied while permitting significant bodymovement. While other devices, such as an elastic sleeve, couldinitially be set at a desired pressure, body movement such as armflexing, would result in tight constriction of the fluid circulation.Use of the resilient protuberances is particularly preferred since itallows rolling of the device over the body part without excessivecompression of the inner surface of the material. Other foam andresilient materials, however, could also be used, e.g. foams which areless dense near the surface which engages the body part.

Another feature of the present invention is that each pressure fingerprovides graduated low pressure to the limb surface, adjustment meansare also provided to increase or decrease the pressure of the fingersagainst the skin.

Still another feature of the present invention is the application of theapparatus to the hand in the form of a glove, or the chest or back, inthe form of a vest.

Further features will become apparent in the following description ofthe embodiments of this invention and from the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of the sleeve of the present inventionfitted to a patient.

FIG. 2 is a detailed perspective view of the sleeve.

FIG. 3 is a detailed perspective view of a piece of convolute plasticfoam material used in the construction of the present invention.

FIG. 4 is a sectional view taken along the line 4--4 of FIG. 2.

FIG. 5 is the sectional view shown in FIG. 4 when a limb is placedinside the sleeve showing compression of the pressure fingers againstthe limb.

FIG. 6 is an end view of FIG. 2.

FIG. 7 is an opposite end view of FIG. 2.

FIG. 8 Is a perspective side view of the sleeve showing VELCRO bandsarrangement attached to the sleeve.

FIG. 9 is a side view of a short sleeve for enclosing a portion of alimb.

FIG. 10 is a side view of a sleeve for enclosing a lower limb includingthe foot.

FIG. 11 is a perspective view of a second embodiment of a sleeveconstructed in accordance with the principles of the present inventionfitted to an arm of a patient.

FIG. 12 is a detailed view of the distal end of the sleeve of FIG. 11.

FIG. 13 is a detailed view, similar to FIG. 12, shown in partialsection.

DESCRIPTION OF THE SPECIFIC EMBODIMENTS

Accordingly, FIG. 1 shows a therapeutic sleeve apparatus 18 of thepresent invention fitted to a patient for treating lymphedema.

FIG. 2 is a detailed perspective view of sleeve 18, which is made from aquadrangle of convoluted foam material 20 (FIG. 3). Convoluted foammaterial is widely used as an under-sheet lining on mattresses. Taperedquadrangle 20 of convoluted foam is cut as shown in FIG. 3, the sides 21can be angle-cut so that the edges meet flush when the foam is rolled toform a tapered sleeve. The foam comprises a base portion 22 having amultiplicity of convolutes or upward-standing fingers 24. Fingers 24 arearranged in a grid pattern formation as shown in FIG. 3, having space 26around each finger end 28. Since the fingers are arranged in rows,avenues or channels of space 30 exist in four different directionsbetween and through these rows as indicated by arrows A,B,C, and D,which lie longitudinally, transversely, diagonally to the right anddiagonally to the left.

Convoluted foam quadrangle 20 is rolled longitudinally, to form aslow-tapering funnel-shaped sleeve 18 (FIGS. 2, 6-9 with the fingersfacing inwardly. Inwardly facing fingers 24 are best seen in crosssection view FIGS. 4 and 5. Sleeve 18 is encased in fabric comprising aninner lining 32 of SPANDEX material, and an outer lining 34 of NYLON(FIGS. 2, 6-9). Any other suitable materials can also be used. Innerlining 32 and outer lining 34 are sewn together at each end, indicatedby numeral 36 (FIGS. 4-6).

Each sleeve's outer lining 34 is encircled by a plurality of adjustableVELCRO straps or bands 38. Each band comprises a length of 50 mm (2")wide loop-side VELCRO band 38, having a first end 40 and a second end42, (FIG. 8). First end 40 is fitted with a single loop ring 44, and isthen sewn at 45 (FIGS. 4 and 5) to outer lining 34. Second end is fittedwith a 50 mm×50 mm (2"×2") square 46 of hook-side VELCRO, which is sewnor adhesively attached near end 42.

Second end 42 is then passed underneath and around sleeve 18 and throughsingle loop ring 44, then doubled back so as to attach hook-side square46 to loop-side band 38. A "D" ring 48, or a self-separating pad, (notshown) is attached to end 42).

Each webbing strap or band 38 can be adjusted tighter or looser toincrease or decrease inward pressure of fingers 24 against the patient'slimb. The adjustment can then be secured by attaching hook-side square46 at end 42 to loop-side band 38.

In like manner, an additional number of encircling webbing bands 38 areprogressively attached along the remainder of the sleeve's outer lining34, keeping them 12.5 mm (1/2") apart (FIGS. 2 and 8).

A short sleeve 50 (FIG. 9), which is about 225 mm (9") long, willrequire three 50 mm (2") wide bands. A 400 mm (16") long sleeve 18, FIG.2, will require 6 bands, while a 76 cm to 99 cm (30" to 39") long sleeve52, (FIG. 10), for a lower limb, would require about 12 to 16 bands.

In addition, to sewing end 40 to the sleeve's outer lining 34 along oneside of sleeve 18, a series of loops 54 (FIG. 7) are sewn at 56 to theopposite side of the sleeve, so as to slidably locate bands 38 in aregular spaced-apart relationship along the sleeve. Each band 38 is freeto slip endwise through loops 54 during tightening or loosening of thebands.

Convoluted foam material can be made in a variety of material density,resulting in harder or softer pressure fingers. Soft for patientsrequiring a lower level of applied pressure while more dense fingers areused for patients requiring high levels of applied pressure, asdescribed more fully below.

FIG. 10 shows a sleeve 52 for a lower limb, which also includespatient's foot. These can be made in various lengths to accommodatelonger and shorter limbs.

When a plane of convoluted foam material shown in FIG. 2, is rolled intoa sleeve with the fingers facing inwardly, the fingers and the fingerends 28 are then located closer together as seen in FIGS. 4 and 5.However, the fingers still maintain the original grid formation, andalso a space between the fingers, and between the rows of fingers stillexist in the four directions mentioned above.

When a limb, such as arm 25 (FIGS. 1 and 5) is placed inside the sleeve,and tightening adjustments made with VELCRO bands 38, the elastomericpressure fingers 24 press against skin 29 around and along the fulllength of the arm. Each pressure finger is separated from the adjacentpressure finger by channel 30 against which no pressure is applied.Shaded areas 31 (FIG. 5) indicate the areas not under pressure, whichform the channels for conveying lymphedema fluids.

It is believed that each small area under pressure changes theinterstitial pressure in the tissues, moving lymphatic fluids into andalong these channels to the lymphatic and venous drainage system.

An alternative construction of the sleeve of the present invention isillustrated in FIGS. 11-13. The sleeve 100 is generally similar to thesleeve illustrated in FIG. 1, except that an outer sleeve 102 comprisesan axial fastener in the form of a zipper 104 which permits the entirelength of the sleeve to be opened and closed to facilitate inserting andwithdrawing the arm A from the sleeve. In some cases, it may besufficient to employ only the zipper 104 to apply a preselected level ofpressure onto the arm. Usually, however, it will still be desirable toprovide a plurality of separate straps 106 which may be constructed asgenerally described above.

A further difference in the sleeve 100 is the inclusion of a pair ofopposed plates 110 and 112, as best observed in FIGS. 12 and 13. Theplates 110 and 112 help apply pressure to the convoluted foam whichengage the hand to the inner sleeve material 120.

In using the devices of FIGS. 1 and 11, it is important to applypressure at the spaced-apart locations on the body surface in a uniformmanner. The pressure applied should be relatively high, but shouldalways be maintained below venous pressure in order to permit continuedblood flow and allow lymphatic and other fluid drainage. The appliedpressure may be measured by interposing a fluid-filled bladder betweenthe body surface and the inner radial tips of the pressure-applyingfingers. The outer sleeve of the device can then be tightenedsufficiently so that the pressure applied by the fingers to the bladderis in the range from 5 mmHg to 60 mmHg, preferably from 10 mmHg to 45mmHg. The pressure should be applied for a time sufficient to reduceswelling, typically being employed overnight. Often, initial treatmentwill involve daily (or nightly) treatments, with maintenance treatmentsoccurring once or twice a week.

The devices illustrated in FIGS. 1 and 11 have been successfullyemployed in a number of test cases. In one case, an arm which had beenswollen of excess lymphatic fluids was reduced in circumference by 50 mm(2") in 2 hours, whereas other prior art pressure devices which had beenused over several days had produced no appreciable reduction. Similarresults were obtained with other patients. Another patient who had beenusing prior art pressure devices without success and who also hadsuffered frequent infections to her arm, was fitted with the presentinvention on a 12 month trial basis; the swelling was soon reduced andno further infections.

Although the present invention is especially directed toward thetreatment of lymphedema, it is envisioned as also being applicable forprevention and/or treatment of embolism or thrombosis, as well as fortreatment of swollen limbs resulting from venous insufficiency.

Those skilled in the art will envision that many other possiblevariations are within its scope. For example skilled artisans willreadily be able to change the thickness or density of the foam, orlength of convolutes, or assembly different combinations of foam, ordesign a different configuration of pressure points and channels. It ispossible to change the arrangement, or widths of the VELCRO bands or usedifferent grades of VELCRO. It is possible to fit other forms of loops,or means to grasp the VELCRO bands when making adjustments. Any suitablematerial can be sued to cover the elastomeric pressure material,including fabric printed with patterns. Other types of foam materialsuch as rubber, plastic air bubbles, foam air bubbles or non-convolutefoam and the like can be used. Different means of installation can beused. Various heights of convolutes can be used to conform to limbshape, and various number of convolutes per square foot can be used.

Accordingly, the reader is requested to determine the scope of theinvention by the appended claims and their legal equivalents, and not bythe examples which have been given.

What is claimed is:
 1. An apparatus for applying pressure to a body partof a patient, said apparatus comprising:an outer sleeve configured toencircle and extend the entire length of said body part; a multiplicityof pressure-applying resilient protrusions within the outer sleeve, theprotrusions being configured to encircle and extend over the entiresurface of the body part and to apply pressure to a surface of said bodypart of said patient; and strap means spaced along said outer sleeve forradially compressing the resilient protrusions onto the body part. 2.The apparatus of claim 1 wherein said multiplicity of pressure applyingprotrusions are spaced apart to provide a multiplicity of high pressurepoints or lines within said body part.
 3. The apparatus of claim 1wherein the fingers have a height from a base to a tip in the range from0.5 cm to 15 cm.
 4. The apparatus of claim 3 wherein the protrusionscomprise fingers arranged in a generally cylindrical envelope withindividual fingers being aligned radially with respect to the axis ofthe cylindrical envelope.
 5. The apparatus of claim 4 intended forapplying pressure to an arm wherein the length of the cylinder is in therange from 3 cm to 200 cm, the bases of the fingers are distributed overa generally cylindrical surface having a diameter in the range from 7.5cm to 75 cm, and the tips of the fingers are distributed over agenerally cylindrical surface having a diameter in the range from 2 cmto 25 cm.
 6. The apparatus of claim 4 wherein the outer sleeve securesthe bases of the finger over a generally cylindrical surface.
 7. Theapparatus of claim 6 wherein the outer sleeve is formed form anon-distensible fabric which can be rolled to form the cylindricalsurface.
 8. The apparatus of claim 7 further comprising an axialfastener which allows the rolled fabric to be opened and closed.
 9. Theapparatus of claim 1 wherein the structure for radially compressing theresilient protrusions comprises a plurality of straps which allow therolled fabric to be adjustably radially inwardly compressed.
 10. Theapparatus of claim 4 further comprising an inner sleeve which covers thetips of the fingers over a generally cylindrical surface.
 11. Theapparatus of claim 1 wherein said multiplicity of protuberancescomprises a sheet of convoluted plastic foam.
 12. The apparatus of claim1 wherein said multiplicity of pressure applying fingers are configuredto apply pressure in a pattern encircling a limb of a patient to providea multiplicity of high pressure points or lines within said limb of saidpatient.
 13. The apparatus of claim 1 wherein said outer sleeve isconfigured to encircle an arm of said patient.
 14. The apparatus ofclaim 1 wherein said outer sleeve is configured to encircle a leg ofsaid patient.
 15. The apparatus of claim 1 wherein said outer sleeve isconfigured to encircle a torso of said patient.
 16. The apparatus ofclaim 1 further comprising an inner sleeve interposed between saidmultiplicity of pressure applying fingers and said limb of said patient.17. The apparatus of claim 5 further comprising a pair of opposed platesarranged to engage opposite sides of a patient's hand when thecylindrical envelope is disposed over an arm.
 18. An apparatus fortreating lymphedema in a limb of a patient comprising:an outer sleeveconfigured to encircle and extend along the entire length of said limbof said patient, a sheet of convoluted plastic foam within said outersleeve having a multiplicity of protuberances defining a multiplicity ofinwardly directed pressure applying fingers configured to apply pressurein a grid-like pattern to a surface of said limb of said patient, saidpressure applying fingers being spaced apart to provide a multiplicityof high pressure points within said limb of said patient and amultiplicity of lower pressure channels between said multiplicity ofhigh pressure points, an inner sleeve interposed between saidmultiplicity of pressure applying fingers and said limb of said patient,and a plurality of strap means configured to tighten said outer sleeveabout said pressure applying fingers upon said limb of said patient. 19.The apparatus of claim 18 wherein said outer sleeve is configured toencircle an arm of said patient.
 20. The apparatus of claim 18 whereinsaid outer sleeve is configured to encircle a leg of said patient.